Is a prolonged bed rest following embryo transfer useful?

A total of 182 infertile patients undergoing in-vitro fertilization (IVF)-embryo transfer were randomly assigned into two groups. Eighty-seven patients (group A) underwent 97 treatment cycles and had 87 embryo transfer procedures followed by a 24 h period of bed rest. Ninety-five patients (group B) underwent 102 treatment cycles and had 93 embryo transfer followed by a 20 min period of bed rest. There were no statistically significant differences seen between the groups with respect to age, duration and causes of infertility and number of previous fertility treatments. The clinical and biological procedures were identical in both groups, the only difference being the length of bed rest. There were 21 pregnancies in group A (pregnancy rate per embryo transfer: 24.1%) while in group B there were 22 (pregnancy rate per embryo transfer: 23.6%). There were four spontaneous miscarriages (19%) and three twin pregnancies (14.2%) in group A, while in group B there were four spontaneous miscarriages (18.1%) and three twin pregnancies (13.6%). None of these values was statistically significant (P > 0.05). This study shows that a 24 h period of bed rest following embryo transfer is not associated with a better outcome of the IVF-embryo transfer when compared with a 20 min rest period. Prolonged bed rest does not appear to influence the implantation rate after IVF-embryo transfer.

Epidural anesthesia in an in vitro fertilization and embryo transfer program.

OBJECTIVES: To investigate the potential advantages of epidural anesthesia in an in vitro fertilization and embryo transfer program. STUDY DESIGN: Between January 1991 and December 1992, 148 infertile patients underwent transvaginal ultrasound guided oocyte retrieval. A total of 44 patients (group A) had 50 retrievals under epidural anesthesia, and 104 patients (group B, control group) 112 retrievals under intravenous sedation (propofol) with mask-assisted ventilation (nitrous oxide). RESULTS: In group A satisfactory anesthesia was achieved in 49 of the 50 cases (98%); one patient required additional intravenous administration of propofol owing to extreme anxiety. No complications were observed. Adversely, in group B nausea was observed in 16 cases (14%) and nausea and vomiting in 7 cases (6%). In group A the fertilization, cleavage and pregnancy rates were 67.2%, 92% and 20% respectively, while in group B the rates were 69.3%, 93% and 19.6% respectively; the differences are not statistically significant. CONCLUSIONS: Epidural anesthesia is an effective method for transvaginal oocyte retrieval but does not improve the treatment outcome as compared to an intravenous sedation with mask-assisted ventilation using propofol and nitrous oxide.

The relationship of uterine and umbilical Doppler resistance to fetal and placental protein synthesis in the second trimester.

The relation of uteroplacental and umbilical Doppler resistance index (RI) to peripheral levels of alphafetoprotein (AFP), human chorionic gonadotrophin (hCG), human placental lactogen (HPL), Schwangerswaft protein (SP1), pregnancy-associated placental protein A (PAPP-A) and insulin-like growth factor binding protein 1 (IGP-BP1) at 16-24 weeks was established in a cross-sectional study of 183 unselected singleton pregnancies. There was an association between high values of uteroplacental RI and high hCG levels, and high umbilical RI values with high hCG and HPL levels. Thus, in the mid-trimester, the levels of some placental proteins seem to be related to placental resistance.

Early prediction of uteroplacental complications of pregnancy using Doppler ultrasound, placental function tests and combination testing.

In a prospective, blind study of 183 unselected women attending for routine booking scan with a singleton pregnancy at 16-24 weeks' gestation, uteroplacental resistance index, and peripheral levels of alpha-fetoprotein, human chorionic gonadotropin, human placental lactogen, Schwangerswaft protein, pregnancy-associated placental protein A and insulin-like growth factor (IGF) binding protein 1 were measured. High levels of alpha-fetoprotein and IGF 1 binding protein 1 (> 90th centile) were associated with small-for-gestational age babies (< 10th centile) (sensitivity 24% and 22%; specificity 90% and 91%). High levels of alpha-fetoprotein, human chorionic gonadotropin and pregnancy-associated placental protein A (> 90th centile) were associated with one or more of three severe complications of pregnancy: very small-for-gestational age (< 3rd centile), severe proteinuric hypertension or intrauterine death (sensitivity 20%, 20% and 57%; specificity 90%, 95% and 91%, respectively). A uteroplacental resistance index > 90th centile was also associated with small-for-gestational age and severe complications (sensitivity 24% and 50%, specificity 90% and 90%). A combination of resistance index and a placental function test improved the prediction for a group of patients that included any complications (sensitivity 31% and specificity 89%). Doppler ultrasound was a more efficient predictor than individual placental function tests but screening predictions can be improved by combining Doppler parameters and placental protein estimations. Combinations of placental function tests might provide equivalent, or complementary, information. This preliminary work demonstrates the potential value of combining biophysical and biochemical tests to predict complications of pregnancy.

Circulating levels of placental protein 14 and progesterone following Mifepristone (RU38486) and Gemeprost for termination of first trimester pregnancy.

Ten patients underwent successful termination of first trimester pregnancies with RU38486 (Mifepristone, Roussel Laboratories Ltd., Broadwater Park, Uxbridge, Middlesex, United Kingdom) followed 2 days later by a prostaglandin (Gemeprost, May and Baker Ltd., Dagenham, Essex, United Kingdom) pessary. Four hours after administration of RU38486, the levels of progesterone (P) started to fall and continued to show a gradual decline until the abortion was completed, when a steep fall to follicular phase values was observed. Levels of placental protein 14 remained unaltered until 2 days after RU38486 administration, when levels were increased. The rise in placental protein 14 in association with falling P concentrations suggests that the decidual secretion of placental protein 14 might be independent of P. Fertil Steril 52:66, 1989.

PIP: Mifepristone (RU38486) when used in conjunction with a vaginal prostaglandin acts as an efficient method of abortion for 1st trimester cases. Ten women were administered RU38486, a synthetic 19-norsteroid that binds to the progesterone (P) receptor. It is given orally and acts as an antagonist the effects of P on target cells. When used with a prostaglandin, Mifepristone has a 100% success rate in termination of an early pregnancy. All of the women were less than 9 weeks pregnant and had no complications. 48 hours after the Mifepristone was administered, the women returned to the hospital for the insertion of a vaginal pessary (Gemeprost, 1 mg). Until the abortion is finished, there is a fall in P levels following the administration of Mifepristone. All patients aborted successfully. No change in levels of placental protein 14 were observed until 48 hours later when levels rose. It is therefore submitted that the secretion of placental protein 14 by the decidua in early pregnancy is not dependent on P and that other factors must be involved.

Chorionic gonadotropin concentration in early human pregnancy: comparison of specific and nonspecific assays.

Daily blood samples were collected during 10 menstrual cycles in which conception had occurred, and changes in circulating concentrations of human chorionic gonadotropin (hCG) were measured simultaneously in specific and nonspecific radioimmunoassays. The hCG concentration profiles were not identical, and the fundamental differences could not be related to differences in technique. Both specific and nonspecific parameters of hCG concentration rose exponentially for the first 2 to 3 weeks following first detection and were thus amenable to linear regression analysis. Doubling times were significantly different at 2.3 and 1.8 days, respectively. Extrapolation of the regression data gave a (theoretical) plasma concentration of 3 IU/liter at 9.5 days after the luteinizing hormone peak using the specific assay but at only 5.5 days using the nonspecific assay. This difference is sufficiently large to suggest the presence of other forms of hCG or its subunits about the time of implantation and during early pregnancy.

Feminization in gonadal dysgenesis associated with ovarian gonadoblastoma.

A case of gonadal dysgenesis in a phenotypic female with XY genotype associated with ovarian gonadoblastoma is reported. Endocrinologic studies suggest that the normal female secondary sex characteristics could be due to estrogen production from luteal intersitial cells.